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BCPS Exam > FEN: Parenteral Nutrition III > Flashcards

FEN: Parenteral Nutrition III Flashcards

1
Q

List five broad categories of PN complications

A
  1. Catheter-related complications
  2. Fluid and electrolyte
  3. Long-term PN complications
  4. Incorrect feeding rate
  5. Incorrect macronutrient formulation
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2
Q

List three catheter-related complications of PN

A
  1. Catheter-related infections
  2. catheter insertion complications
  3. Peripheral venous thrombophlebitis
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3
Q

List two fluid and electrolyte complications of PN

A
  1. Fluid imbalance

2. Acid base imbalance

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4
Q

List four long term complications of PN

A
  1. Aluminum toxicity*
  2. Hepatobiliary disorders
  3. Osteoporosis and osteromalacia
  4. Gut atrophy
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5
Q

List two complications related to incorrect feeding rate

A
  1. Overfeeding

2. Refeeding syndrome

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6
Q

List two complications related to incorrect macronutrient formulation

A
  1. Hyperglycemia

2. Essential fatty acid deficiency

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7
Q

Catheter related infections are caused primarily by what two microorganisms?

A
  1. Staphylococcus aureus

2. Candida albicans

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8
Q

List two types of catheter insertion complications

A
  1. pneumothorax

2. incorrect placement

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9
Q

How to prevent peripheral venous thrombophlebitis from PN?

A

Peripheral venous thrombophlebitis can occur with peripheral catheter placement. Risk is increased by day 4 of catheterization; therefore, site should be rotated every 3 days.

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10
Q

Acid-base imbalances: excessive _____ salts in the PN can cause a metabolic acidosis; whereas excessive _____ salts in the PN can cause a metabolic alkalosis

A
  1. Excessive chloride salts can cause a metabolic acidosis

2. Excessive acetate salts can cause a metabolic alkalosis

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11
Q

Hyperglycemia resulting from PN can lead to ____ and ____ infections

A
  1. Nosocomial infections

2. Wound infections

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12
Q

List four complications of overfeeding

A
  1. Hepatic steatosis
  2. Hypercapnia (e.g. harder to wean from ventilator)
  3. Hyperglycemia
  4. Azotemia
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13
Q

How quickly can essential fatty acid deficiency develop with PN, and what kind of PN is likely to cause it?

A

1-3 weeks of a lipid-free PN

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14
Q

List seven symptoms of essential fatty acid deficiency?

A
  1. skin desquamation
  2. hair loss
  3. impaired wound healing
  4. hepatomegaly
  5. thrombocytopenia
  6. fatty liver
  7. anemia
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15
Q

What are three symptoms that characterize refeeding syndrome?

A
  1. Hypophosphatemia
  2. Hypokalemia
  3. Hypomagnesemia
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16
Q

What are the three late complications of refeeding syndrome?

A
  1. Cardiac dysfunction
  2. Respiratory dysfunction
  3. Death
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17
Q

What are three steps in preventing refeeding syndrome?

A
  1. Identify patients at risk
  2. Start slow
  3. Supplement before initiating PN and monitor
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18
Q

What seven patients are at risk for refeeding syndrome?

A
  1. Anorexia
  2. Alcoholism
  3. Cancer
  4. Chronically ill
  5. Poor nutritional intake for 1-2 weeks
  6. Recent unintentional weight loss
  7. Malabsorption
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19
Q

How to start slow with refeeding syndrome?

A

Initially provide less than 50% of caloric requirements, and advance over several days to desired goal.

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20
Q

How to supplement and monitor to prevent refeeding syndrome?

A
  1. Before initiating PN, supplement vitamins as well as K+, phosphate and magnesium if needed.
  2. Monitor daily for at least 1 week
  3. Replace electrolytes as needed, many patients will need aggressive replacement during first week of PN.
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21
Q

Aluminum toxicity is most likely to occur in what two types of patients?

A
  1. Receiving long-term PN

2. Renal dysfunction

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22
Q

Why is aluminum toxicity more likely to occur in patients with renal dysfunction?

A

Aluminum is eliminated renally

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23
Q

List three complications of aluminum toxicity

A
  1. Osteopenia
  2. Neurotoxicity
  3. Microcytic anemia
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24
Q

How does aluminum toxicity cause osteopenia?

A

Accumulates in bone and interferes with bone Ca2+ uptake

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25
Q

How does aluminum get into the patients body?

A

Contaminates many IV electrolytes and IV fluids

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26
Q

How to find out how much aluminum a patient is receiving due to contamination?

A

Aluminum content documented on drug labels

27
Q

List three hepatobiliary disorders resulting from PN

A
  1. Steatosis
  2. Cholestasis
  3. Gallbladder stasis: sludge, stones, cholecystitis
28
Q

What is the typical cause of steatosis from PN?

A

Overfeeding

29
Q

How does steatosis present in early stages?

A

Transient elevation in aminotransferase concentrations

30
Q

How does steatosis present in late stages?

A

Fibrosis or cirrhosis

31
Q

In whom does cholestasis usually appear in from PN?

A
  1. Usually children

2. Also adults receiving long-term PN

32
Q

What is the primary sign of cholestasis resulting from PN?

A

Conjugated bilirubinc oncentration greater than 2 mg/dL

33
Q

Why does gallbladder stasis occur in patients receiving PN?

A

Gall bladder stasis is associated with the development of gallstones, sludge and cholecystitis; it is more attributable to a lack of EN than to PN administration.

34
Q

List two reasons osteoporosis and osteomalacia can develop in patients receiving long-term PN

A
  1. Higher protein doses cause increaased Ca2+ excretion

2. Chronic metabolic acidosis because of insufficient acetate

35
Q

List six, general monitoring categories for patients receiving PN

A
  1. Infection and phlebitis
  2. Fluid and general nutritional status
  3. Salts: Electrolyte and acid/base
  4. Fats and sugars
  5. Liver
  6. Readiness to switch
36
Q

List two kinds of monitoring related to infection and phlebitis

A
  1. Infection

2. Peripheral vein thrombophlebitis or infiltration

37
Q

List two kinds of monitoring related to fluid and general nutritional status

A
  1. Fluid status

2. General Nutritional status

38
Q

List two kinds of monitoring related to salts

A
  1. Electrolytes

2. Acid-base

39
Q

List three kinds of monitoring related to fats and sugars

A
  1. Hyperglycemia
  2. Hypoglycemia
  3. Triglyceride
40
Q

List one kind of monitoring related to liver

A

Hepatic function tests

41
Q

List one kind of monitoring related to readiness to switch

A

Montior for patient readiness for oral or EN support

42
Q

List three monitoring parameters for infection in patients receiving PN

A
  1. Temperature
  2. WBC
  3. Intravenous access site
43
Q

List three symptoms of peripheral vein thrombophlebitis

A
  1. Pain
  2. Erythema
  3. Tenderness
44
Q

What is a symptom of infiltration that is different from peripheral vein thrombophlebitis

A

Palpable cord at the site of the peripheral vein

45
Q

How to treat peripheral vein thrombophlebitis or infiltration?

A

Remove catheter

46
Q

List five monitoring parameters for fluid status in patients receiving PN

A
  1. Weight
  2. Edema
  3. Vital signs
  4. Input and output
  5. Temperature
47
Q

What lab value is useful for monitoring the effects of long-term nutrition support? What patients is not used in? Why is it superior to a related lab value?

A

Prealbumin (not critically ill) because it has a shorter half-life than albumin

48
Q

What are the three ranges for prealbumin? (Normal, moderate malnutrition, severe malnutrition)

A
  1. Normal rangge: 16-40 mg/dL
  2. Moderate malnutrition, 11-16 mg/dL
  3. Severe malnutrition, less than 11 mg/dL
49
Q

How to use prealbumin to track progress towards goal in malnourished patients?

A

Goal for malnourished patients is an increase of at least 3-5 mg/dL until within normal range.

50
Q

Why is serum albumin a poor predictor of nutritional status?

A

Serum albumin (normal 3.5-5 g/dL) is a poor predicator of nutritionl status because it has a long half-life, and concentrations fluctuate during illness.

51
Q

What is a common blood glucose goal in patients receiving PN?

A

140-180 mg/dL

52
Q

____ (initially ___ to ___ units per g of dextrose) can be added to the PN for patients using a consistent dosage to control hyperglycemia

A
  1. Regular insulin

2. 0.05-0.2 units per g of dextrose

53
Q

Abrupt discontinuation of PN is usually tolerated in _____ patients

A

Nondiabetic

54
Q

What can happen in diabetic patients who have PN abruptly discontinued?

A

Rebound hypoglycemia

55
Q

List two strategies to prevent rebound hypoglycemia in diabetic patients receiving PN?

A
  1. If PN is discontinued abruptly, rebound hypoglycemia can be avoided by administering 5% or 10% dextrose.
  2. Or, you can gradually taper off of PN over 1-2 hours.
  3. Check BG 30 minutes to 1 hour after discontinuing PN.
56
Q

Monitor for electrolyte and acid-base imbalances. The ____ and ___ salts can be adjusted on the basis of acid-base status of the patient.

A
  1. chloride

2. acetate salts

57
Q

For metabolic alkalosis, Na2+ and K+ can be administered as _____ salts

A

Chloride

58
Q

For metabolic acidosis, Na+ and K+ can be administered as the _____ salts. Why?

A
  1. Acetate

2. Acetate is converted to bicarbonate

59
Q

What should you adjust in patients receiving PN with respiratory acid-base disorders?

A
  1. Correct the underlying cause (e.g. overfeeding)

2. Adjust the ventilator settings as needed

60
Q

Withhold lipids in patients with a triglyceride concentration greater than _____

A

400 mg/dL

61
Q

When calculating lipid requirements for PN, account for any _____ mixed in a lipid emulsion. Give two examples

A
  1. Drugs
  2. Propofol
  3. Clevidipine
62
Q

List two categories of patients that may transition from PN to EN or oral

A
  1. Well-nourished, healthy patients

2. Older adult, debilitated, or malnourished patients

63
Q

How to transition from PN to EN or oral in a well-nourished, healthy patient?

A
  1. Well-nourished, healthy patients can change immediately from PN to oral or EN
64
Q

How to transition from PN to EN or oral in an older adult, debilitated, or malnourished patient?

A
  1. Older adult, debilitated or malnourished patients may need a transition period in which oral or EN feedings are gradually increased, coinciding with a reduction in PN.

BCPS Exam (34 decks)

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